The Black Belt

Excited to announce this piece was published on the wonderful Opiana blog ! Check it out at the link or read below… Continue reading “The Black Belt”

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Welcome to Third Year

It would be hard to miss her. She walked into the atrium, towering tall in a bright orange jumpsuit. She was led down the hallway, her handcuffed arms held straight out in front of her, palms parted as though to grasp a bouquet of flowers.

When we saw them later that afternoon, they were uncuffed, poking through flimsy sleeves of the hospital gown she was given. Without her body wrapped in its orange uniform, or the security guard sitting at the foot of her bed, you wouldn’t know she came from the prison. She now matched her neighbors, donning that sad sky blue material, that pitiful excuse for a color. The one decorating most healthcare facilities, the one that is supposed to warm up sterile rooms and hearts alike while failing at both. Continue reading “Welcome to Third Year”

Pennyroyal: a less than royal mint

I wrote this a while and submitted it to Physicians for Reproductive Health blog where it was published. Click here for a link to it, or read below.


Last summer, I received funding from the national network of Medical Students for Choice to do an externship in Mexico City. This externship consists of spending two weeks observing in an abortion clinic. But before this…a little detour to Oaxaca.

The week before starting at the clinic, my boyfriend and I planned a short but sweet three-day vacation in Oaxaca, just an hour flight away from Mexico City. The first day passed blissfully. We spent it strolling and tasting our way through the city’s cobblestone streets. The next day, we embarked on what was promised to be a beautiful adventure, hiking through the Mancomunados villages of the nearby Sierra Norte mountains. We started in a pueblo called Cuajimoloyas and headed out for the six-hour trek with our guide, an ageless local named Jose. Over and under trees we trekked, stumbling through fields of wild flowers, happening upon a newborn baby goat, discovering agaves with shoots 50 feet tall. I had asked Jose to share any knowledge he had of the plants, particularly the medicinal plants, which only seemed appropriate as a medical student.

He first showed us poleo, explaining how it is typically used for the stomach and digestion. As we had spent the previous day eating the entirety of Oaxaca’s food supply, these leaves looked quite tasty to my intestines. I popped a few in my mouth and on we went. When we passed another bush I snagged a few more, asking Jose if one can eat too much poleo.“No, no pasa nada,” he responded. And with the trust that comes from pure idiotic ignorance, I chomped on a few more.

We pressed on, heading to Latuvi, a small town perched high within a sea of mountains and known for its abundance of peaches and apples. Hours later I was hot and tired but motivated by the pulque tour and sweat lodge waiting for us at the end. However, when we made it to Latuvi that’s where it all ended. Or began. The poleo that Jose promised wouldn’t cause any harm decided otherwise.
Continue reading “Pennyroyal: a less than royal mint”

Finding your Dx

Recently, I wrote this email:

Hi Dr. W,

I was a patient of yours in 2006 when I started at Scripps college.

I’ve thought about you many times as the years have passed, how lucky I was to receive such wonderful care. I am proud to say I have never relapsed since, and am strong, healthy and happy. In fact, I am now a medical student at Tulane, hoping to pay it forward. 

Thank you for your work,

Alana 

I’ve heard a lot about the self-pathologizing that happens in medical school. How everyone will start to think they have the various diseases we learn about. With my own family history of hyperchondriasis, I too, have been waiting to find my rare diagnosis. Waiting to learn about the condition that pieces together all the symptoms I didn’t even know I had. Luckily, by now we’ve gone those most of the bodies systems, and my bones, blood, and organs have come out “unremarkable”.

Then we started on the brain.

Continue reading “Finding your Dx”

Unsolicited Advice

I have always been a wanderer. My mother always kept an eye on me as I would drift from the crowd to find a quiet place to play. On family bike trips I would speed past my family until the road came to an end, or sprint ahead on a hiking trail losing myself in the monotonous beauty of oak trees until I was called back by the shouting of my name as they searched for me. As social as I was, I always needed time to be alone, time to be bored. Time long enough for boredom to turn into daydreams, for daydreams to turn into fantasies, and for fantasies to turn into inspiration.

I do not wander to get lost, although it sometimes happens. Two feet guide my steps, the right slightly larger than the left. Two hands balance my stride, one soft holding no expectations, while the other clutches to a small hope for discovery.


At the library a few weeks ago, I asked to share a table with a girl pouring over pages of organic chemistry. Because I cannot help myself (I am my mother’s daughter after all), I asked what she was studying. She told me she was studying for the MCAT exam. I could have guessed from the tired and desperate look in her eyes. A look I haven’t seen on myself for a while, but remember all too well. I sat down and pulled out my books on pathology and Step 1 Exam prep.

I promise it gets much more interesting, I said with a smile. Continue reading “Unsolicited Advice”

if 28 could talk

Today I reached the end of my twenties. I turned a beautifully odd 29 years old.

A year ago today, Trump stole my birthday. It’s hard to believe an entire year has passed since that pitiful excuse for a human was elected president. Trying to even recall all the things that have since happened this passed year feels impossible.

Truth is, I’ve always loved birthdays, my birthday in particular (duh). I like them because they offer a day of reflection. True, there are many other markers of change throughout the year, new years of all sorts, seasons, solar phenomenas…ideally every day should be a day to remember all that we have learned, and channel that into our best selves. But really, who has time for that?

So I take this day as an opportunity to remember a few lessons 28 taught me. Continue reading “if 28 could talk”

Abortion: when politics meets practice

The first day of my externship I arrived to a sweet little 3 story clinic tucked between mom and pop shops in a residential neighborhood in Mexico City’s Avante neighborhood. I showed up ready and eager. I had done my research: spoken to previous students who had attended the clinic, read up on procedural standards, researched the history of reproductive rights in Latin America, and familiarized myself with the current policies that highlight Mexico City as a sanctuary within the country at large*. This new information added an extra pep to my steps alongside the pro-choice activism I’ve been engaged with through medical, political, and social spheres. These two weeks were to be an officiation, a baptism of sorts; a way to fully immerse myself in the work I’ve been so passionate about.

The experience was structured for me to follow patients throughout their visits. First, was the medical consultation where clinical histories were taken, ultrasounds performed to confirm gestational ages, and discussion were had about birth control options moving forward. Second, was the counseling session with the psychologist. Recognizing that most patients arrived resolute, the purpose was not to help women make a decision. Rather, it served as a space to reflect on a woman’s ability to decide, to have control over her life and body, to help strengthen her ability to confront fears and conflicts, both internal and external. At the end of the session patients received their medications. As preventative measures, a dose of antibiotics and ibuprofen; as preparatory, a dose of misoprostol**. Lastly, they moved to the operating room for a 15 minute procedure that started with paracervical anesthesia***, then cervical dilation, and lastly manual vacuum aspiration.

Like a mute shadow, I followed along, observing. Each stop through the process showed a new depth of compassion offered by members of the clinical team to the women that passed through their care. I was touched, inspired really.

Until I saw my first abortion. Halfway through the procedure I had to dismiss myself and sit in the hallway outside. I heard the nurse speak softly to the patient, “Breathe in, hold for 3, breathe out,” and I followed along. 

When it was over, the doctor came out and met me with just as much kindness as he did his patients. Just breathe, sit down whenever you need to. Let us know if it ever becomes too much, he told me. This happens everyone’s first time, he said with a smile. But that was just the problem. See, I wasn’t supposed to be this grossed out. This is the work I had come here to do, this is what I had prepared myself for. I wanted so badly to be a model student, to not be everyone else.

Like most falls from hubris, the fact was I was just disappointed in myself. Disappointed that I couldn’t handle it, and even more disappointed that I had assumed otherwise. The truth is that there are some experiences no amount of work can prepare you for. Some journeys have no shortcuts and the only one road to take is the one that passes through. So it was and I continued down the path. 

I wish I could say that each day it became easier. But that is not what happened. I did not learn to disconnect myself, nor to stop imagining the sensations of what I saw. I did not learn how to still my focus on the procedure or concentrate on the anatomy involved.

And as the days turned to weeks, I learned this was okay. These are skills that can come with time and practice. Instead, the experience taught me more important lessons.

I learned that abortions are not pretty, they are not fun, and they are not a desired procedure. But they have always been necessary, and as long as human continue to mate, they will remain necessarily. That women will always need access to abortion services is not up for debate. Rather, the question is always how, where, and in what conditions they occur. Quality care goes beyond safety. It requires honesty, trust, and difficult conversations, as much as it does tender handholding and empathy.

I learned not to minimize abortions; that the experiences they bring are as varied as the women who have them. As a physical procedure, they can bring the pain of invasion as much as they can an ecstasy of liberation, a reclaiming of one’s body. As a process, abortions span an ocean of emotions where despair and relief, fear and gratitude, loneliness and solidarity are tangled up like seaweed.

As future abortion providers, our job involves more than a procedure. It requires meeting women where they are at, walking with them and providing a safe space to support them through their process, whatever form theirs might take.

 

 

 

* In Mexico, similar to the U.S., states are able to regulate the national abortion law, which only mandates approval for abortions in cases of rape or incest. Although other exceptions exists such as when the life or health of the mother is at risk, for socioeconomic security, or for the health of the fetus, these vary on a state by state basis. Then 2007 rolled around and Mexico City brought with it the decriminalization of all first trimester abortions. As of now it sits in the middle of a country as a quasi sanctuary city for women seeking safe abortions. Women come from other states of Mexico and other countries, as far away as Brazil and as close as El Paso, Texas.

** Depending on the gestational age, misoprostol was taken either sublingually (when less than 12 weeks) and buccally (when over 12 weeks), to contract uterine muscles, helping preventing perforation, and to dilate the cervix.

*** For pregnancies over 15 weeks general anesthesia is used.

 

 

Footprints

What would you say is the most important thing in life?

Health and knowing how to live in this world; knowing how to enter a place and how to leave.

There are many ways to leave a footprint and many types of footprints to leave. There are the ones in a dust pile that scatter with the next step; the ones in sand that wash away when the tide comes in; and those accidental ones in freshly poured concrete that continue to harden over time.

About five weeks ago, I landed in Fortaleza. It is a large city on Brazil’s Northeast coast that has sat a the center of the recent Zika epidemic. I came down to study the relationship between Brazil’s restrictive abortion laws and the response to this public health crisis. Specifically, I wanted to identify the challenges healthcare providers face when caring for women with Zika-affected pregnancies, given the high correlation with fetal microcephaly. Questions such as how providers advocate for patients, decide on appropriate follow-up procedures, discuss pregnancy options, and respond to patient concerns within a rigid policial and legal framework. 

As luck wouldn’t have it, a few days before my flight I got a rejection letter from a grant for research funding. But my ticket and visa were already purchased. So with that I made my entrance with a little notebook covered in seahorses, some rusty Portuguese, and hope that I hadn’t just made a huge mistake.

Within days after arriving, the heavy disappointment of rejection turned into a relief. I soon realized that had the project been approved, it would have been a tremendous failure. There simply weren’t any new Zika cases to look at. So instead I roamed around the maternity hospital I had been connected to, getting passed among doctors and residents who didn’t mind an eager tag-along. The first couple weeks I spent helping women with large bellies rolled on and off exam tables. During prenatal checkups I took blood pressures, ran measuring tapes from pelvic bones and uterine ceilings, and listened to fetal heartbeats; during ultrasounds I stood in the dark cold room staring at a screen that measured gestational age and health but looked more to me like Escher drawings than any identifiable body parts.

Although Zika-associated microcephaly was no longer on the table, I began paying attention to issues of other maternal-fetal complications. Perhaps these cases would open up similar discussions. At first, I did not hear the conversations I was looking for. The fact of the matter is that in a country where abortion is illegal, these conversations are not obvious. If they happen at all they seem hinted at, touched upon, broken into bite-sized chunks for you to piece together on your own. They require other senses.

But as the days passed, they slowly began to appear. I found them in the absence of patient questions, in the muffled “thank you”s, and silent head shaking. They were in the tears of women who received devastating diagnoses in the ultrasound room. They were in the rejection of a patient’s request to have her tubes tied with her C-section. They were in the swift change of conversation when I began to ask questions.

By slowly connecting the dots, I eventually found who I was looking for. My third week I arrived at Dra. D’s office door. She was the one who facilitated the few legal abortions allowed by the hospital. She met with patients who came looking to terminate pregnancies resulting from sexual assault. It was incredible to watch her work with patients. Her words soothed their wounds and calmed their cries, yet she was firm in her counsel. She promised they would be cared for without sugarcoating the truth of the challenges that still lay ahead. When they collapsed into their chair she did not take them into her arms; instead she helped them stand stronger, walking with them as they navigated the hospital side by side.

This was actually a small part of the work she did as an Ob/Gyn and sexologist. Each day with her was a whirlwind of patients, cases, conversations I could have never planned for:

  • a walk through one of the few psych hospitals where heavily sedated men with glazed eyes sat scattered through hallways and open courtyards
  • a training on transexual health for hospital staff, many of whom had never heard the word before
  • a support group for patients with multiple sclerosis 
  • couple’s therapy where they shared the intimate details of their sex life and relationship woes
  • trans patients looking to begin their transition process
  • Play-Doh therapy with a 3 year-old with a suspected case of sexual abuse
  • life lessons taught to residents about feminism and empathy for their patients
  • physical therapy for a patient with vaginismus
  • identifying a learning disability in a 14 yr old patient who couldn’t find her country on a world map

One of the best days was when I joined the last day of a 5 class course. It was a support group for women with sexual dysfunctions of various types. They had already covered questions of physiology, biology, social constructs of sexuality, religious influences, relationships, etc. The day I arrived was about pleasure and eroticism. Dra. D split us into pairs and distributed an assortment of items, which we had to incorporate into a story. I got a massage wax candle, a small vibrator, and a dice with different sexual positions on each of the six sides. At first most women were quiet, shy or giggling with embarrassment. But not my 60 something yr old partner who order me as the scribe to the heated saga she began to tell. When it came time to share, the room erupted in applause and laughter as women surprised even themselves with the erotic stories they created.

So while my proposed study failed died before it began, the experiences I had were ones which seemed to answer the questions I had better than anything I could have planned for or imagined. As my five weeks in Brazil come to an end I’m curious to see what comes of these footprints. Both those I have made and those which I have stepped into. Only time will tell. 

For now there seems to be only one way to leave: humbled by the generosity that greeted me, inspired by the stories I bore witness to, and motivated to take on the hard work that lies ahead.

Fortaleza: Part 2

Monday morning she was back in the waiting room. With the nervous look of a girl embarking on her first sleepover, she had her pink backpack on her lap, ready for however many days the hospital would be her new home.

She would have to initiate and terminate her pregnancy under the careful watch of the hospital. First, they would administer a dose of misoprostol vaginally to stimulate uterine contractions. After six hours, an anesthesiologist and Ob/Gyn would perform a D&C (Dilation and Curettage); in reality, a procedure that is longer and more invasive than most protocols recommended for her pregnancy of only 7 weeks.

The reason for this? Like most questions of “why?” here, the answer is unclear. Maybe this is for her safety.  Maybe the hospital doesn’t have access to the Mifepristone or vacuum aspirators typically recommended. Or maybe the additional procedures offer financial incentives that outweigh the health of the patient.

Time certainly wasn’t the issue. They had no problem keeping her in a room waiting for a doctor to see her with the misoprostol to begin the abortive process. The problem was that when he rounded on patients he skipped her room, repeatedly. What she thought was first a mistaken overlook, it became clear the doctor was actively avoiding her. Dr. B doctor warned her to be prepared for these so-called conscientious objecters. So she waited, hoping the next doctor on-duty would be more empathetic. But day 1 passed and still no one came to see her. She closed her eyes and prayed tomorrow would bring better luck.

Dr. B told her to be strong, but as day 2 came and went her patience turned to desparation; she had a daughter to take care of, a job to work, and a life she wanted to get back to normalcy. When she could wait no longer, she called Dr. B, alerting her team to what was happening. Phone calls were made, words were exchanged and on day 3 the patient was finally attended to and discharged from the hospital.

Maybe the invasiveness and time consuming nature of the procedure will serve as a reminder to be more careful next time.

Maybe next time she shouldn’t talk to strangers, shouldn’t drink, shouldn’t go out at night, shouldn’t leave her daughter with her parents.

Maybe she should be a better mother, a better daughter, a better woman.

Yes, maybe this time she would learn her lesson.

A fortaleza dentro da Fortaleza: Part 1

 (a strength within Fortaleza)

Two women from Fortaleza walk into a clinic. 

Their lives outside the door existed worlds apart in the same city. But walking inside, their differences became trivial in the new situation they found themselves in.

They were both young mothers, both had been raped, and both wanted to terminate the pregnancy that resulted from the assault. They both were being drawn through the onerous path of seeking a legal medical abortion in Brazil*. They were both resolute in their decision. They had to be, or it’s unlikely they would make it through the process.

A process, which forces them to divulge the details of the violent event multiple times, to multiple people; to meet with a psychiatrist, a social worker, and a nurse, who then pass her on to the doctor, who then passes her to the ultrasound specialists. There, they insert a large probe into her vagina to measure the gestation age of the fetus in order to verify her story and timeline as truthful. She lies in the dark, eyes pinned to the ceiling above, as the fetus’ heartbeat plays from the machine, echoing off walls around her.

From there she is passed back to the doctor, who then passes her back to the psychiatrist, social worker, and nurse who have her sign multiple documents to double, triple and quadruple check that she understands her decision. Even after all this, today will not be the day both of them had prepared themselves for. There will still be time to change their minds, four days in fact, or weeks even, if they wanted to ponder this longer.

They both shook their heads.

They would be back after the weekend.

Why the weekend? The doctor and staff who oversee at these cases of pregnancy terminations do not work on the weekends. In the rare case that a patient had to stay in the hospital, they wouldn’t want her care to be taken over by just whoever was working.

As doctor explained to them both:

know that while you are with our team, everyone you pass through is here to help and care for you in any way we legally can. But not every medical profession will support the decision you are making, and some of them will make sure to tell you so. In these cases, tem que ter fortaleza [you have to be strong].

Two women from a clinic walk into fortaleza

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*There are three legal exceptions Brazil has to its strict anti-abortion laws: (1) in the case of sexual violence, (2) when the life of the mother is at risk, or (3) when the fetus is “incompatible with life”, which is only considered for anencephaly.